FAQ

1. What is the FFK Health First?

FFK-Health First will allow the employees and their eligible dependents of our Employee Benefits Clients, access to medical services at over 155+ participating providers’ island wide. At the presentation of your membership card all FFK-Health First members will receive preferred pricing at participating Medical Centers, Pharmacies, Laboratories, Specialists, General Practitioners, etc.

2. What are the requirements for being a provider?

Memorandum of Understanding (MOU): The MOU outlines the requirement and obligations of Fraser Fontaine & Kong Limited and the providers under the FFK Value Added Services (VAS) provider network.

3. What are the benefits of becoming a FFK preferred provider?

Opportunity to showcase Company by participating in outreach programmes at Corporate locations

Referral to partners for any future business and marketing opportunities

4. Is a new swipe card issued annually?

No, while a new benefit card is issued on renewal, the swipe card does not have an expiry date and should be retained.

5. Is there a cost to replace lost health cards?

Yes. The cost per card is $300.00

6. Can I make a claim if the Drug limit as been maximized?

Yes, once you have satisfied your deductible, benefits such has Drugs and Lab will be reimbursed once a claim form and receipts are submitted.

7.What is a deductible?

An out of pocket expense paid by the member before major medical benefit is payable.

8. Why is preauthorization required for special procedures?

It is stipulated to ensure that the service being sought is necessary and to give the member and estimate to how much the insurance will cover.

9. Why are Over The Counter Drugs ”OTC” excluded?

The plan was not designed to facilitate the purchase of drugs and medication which are easily accessed OTC, but rather those which are prescription items.

10. Why are overseas providers not paid by the insurance?

The plan is a Jamaican dollar plan. For non-emergency services obtained overseas, these will be paid on a reimbursement basis only according to the Schedule of Benefits .

11. Does Dental & Optical go into Major Medical?

No. This is a basic benefit and once the credit limit has been maximized all other charges will be the responsibility of the member.

12. What is the Average Clause?

The Average Clause (Under-Insurance clause) sets out the basis for settlement of loss, where the property is under-insured. If at the time of a loss the property is insured for less than the true replacement value, the insured is considered to be his own insurer for such proportion of the loss as the sum insured bears in relation to the total value of the property. That is, in the case of a partial loss, the Insured is required to contribute to the claim settlement, in direct proportion to the degree of under-insurance.

13. What is the policy Excess?

The Excess (or deductible) is the amount deducted from each claim settlement, after the application of all other terms of the Policy. The excess therefore represents the portion of all claims settlements, for which you are responsible. Loss falling within the limit of the excess must be borne entirely by the Insured.

14. What is the Policy Limit of Indemnity?

The Limit of indemnity represents the maximum that the Insurer will pay for claims arising from any occurrence covered by the Policy.

15. What is the Policy Scope of Cover?

A description of the standard cover provided by the insurer.

16. What are Extension Clause(s)?

Clauses added to the contract to widen the scope of cover.

17. What are Exclusions & Limitations?

A brief description of the more significant exposures not covered by the policy.

18. Premium

An indication of the premium cost and where appropriate, detailed calculations.

19. Insurer

The name of the Company with whom the cover and premium have been negotiated

20. What is The Proposal Form?

Proposal form is the most important document required for the insurance contract between the insured and insurance company. It includes the insured’s fundamental information like address, age, name, education, occupation etc. This form is used by Insurers to gather information about the risk to be insured and is also use by the insurer to calculate all the potential risks in relation to the insurance policy and hence deciding the premium amount.

All the questions must, therefore, be answered truthfully and any material facts should be disclosed. A material fact is any information an Insurer would regard as likely to influence their assessment and acceptance of a risk

HOW TO ACCESS BENEFITS

Always use your membership card at the health provider.

Ask your doctor, where possible, to prescribe generic drugs which are as good as brand name drugs.

Only policyholders and dependents can use the health card.

You risk cancellation of your policy if the card is used by any other than those named in the policy.

HOW TO CLAIM

Obtain a receipt and a completed claim form Showing:

Policy Number, name of patient, date and charge or service, Doctors name and diagnosis

For prescription drugs; the name and cost of the drug

Drug, name of the doctor who prescribed the drug.

CLAIMS MUST BE SUBMITTED WITHIN 90 DAYS AFTER SERVICE DATE & WILL NOT BE PROCESSED AFTER

SPECIAL FEATURES

Major Medical (MM) In the event of a large claim, Major Medical provides additional benefits to reduce your out of pocket expenses up to $3,000,000.00

Overage Dependent Coverage (19-23 years if registered as a fulltime student)

Overseas Emergency

For emergencies that occur within a 30day period while traveling abroad.

National Health Fund/ Sagicor Life – Coordination of Benefits, to reduce prescription cost to members. Members with chronic illnesses (e.g. Diabetes, Hypertension, Asthma, etc.) that are covered by the NHF are encouraged to register with the National Health Fund.

UCR – Usual Customary & Reasonable Charges

MM – Major Medical

Local Deductible: An out of pocket expense borne by the insured before the major medical benefit is payable.